TLR7多态性及血清TLR7/IL-23/IL-17变化与COPD合并肺部感染的关联

Association between TLR7 polymorphism,variation levels of serum TLR7/IL-23/IL-17 and pulmonary infection in COPD patients

目的 探讨慢性阻塞性肺疾病(COPD)合并肺部感染患者Toll样受体7(TLR7)多态性及血清TLR7/白细胞介素-17(IL-17)/白细胞介素-23(IL-23)水平变化。方法 选择海口市中医医院呼吸内科2018年10月-2020年10月收治的COPD合并肺部感染患者75例作为研究对象纳入研究组。选择同期医院收治的COPD未合并感染者80例纳入对照组,入组时抽取外周静脉血,采用聚合酶链式扩增反应检测TLR7基因rs3853839位点基因型分布,以测序结果确定基因分型。根据肺部感染评分对研究组患者肺部感染严重程度进行评价。结果研究组CC基因型、C等位基因频率高于对照组(P<0.05),校正性别、年龄、COPD病程、合并糖尿病、合并哮喘及合并吸烟情况等常量因素后,Logistic回归分析结果显示携带TLR7基因rs3853839位点CC基因型、C等位基因是COPD合并肺部感染的独立影响因素(P<0.05);三组患者血清TLR7、IL-17、IL-23整体水平差异具有统计学意义(P<0.05),CC型研究组患者血清TLR7、IL-17、IL-23水平高于GG和GC型(P<0.05);重度感染组CC基因型、C等位基因频率及TLR7、IL-17、IL-23水平高于轻度及中度组(P<0.05)。结论 TLR7基因rs3853839位点CC基因型、C等位基因增加COPD患者肺部感染风险,其作用机制可能与TLR7/IL-17/IL-23水平有关。

OBJECTIVE To explore the Toll like receptor 7(TLR7) polymorphism and changes of serum TLR7/Interleukin-17(IL-17) and lung infection/Interleukin-23(IL-23) levels in patients with chronic obstructive pulmonary disease(COPD). METHODS Total of 75 COPD patients complicated with pulmonary infection who were admitted to the Department of Respiratory Medicine of our hospital from Oct 2018 to Oct 2020 were recruited as the research objects and divided into the the study group. 80 COPD patients without infection in the hospital during the same period were in the control group. Peripheral venous blood was drawn and polymerase chain amplification reaction(PCR) was used to detect the genotype distribution of TLR7 gene RS3853839 and genotype. According to the lung infection score, the severity of lung infection in the study group was evaluated. RESULTS The CC genotype and C allele frequency in the study group were significantly higher than those in the control group(P<0.05). After gender, age, COPD course, combined diabetes, combined asthma, combined smoking and other constant factors being adjusted, the logistic regression analysis showed that CC genotype and C allele at the rs3853839 locus of the TLR7 gene were independent influencing factors for COPD complicated with lung infection(P<0.05). The differences in overall serum TLR7, IL-17 and IL-23 levels among the three groups were significantly different(P<0.05). The serum TLR7, IL-17, and IL-23 levels in patients carrying CC genotype in the study group were significantly higher than those carrying GG and GC genotypes(P<0.05). The gene frequency of CC genotype, C alleles and levels of TLR7, IL-17, and IL-23 in the severe infection group were significantly higher than those in the mild and moderate groups(P<0.05). CONCLUSION The CC genotype and C allele at rs3853839 of TLR7 gene significantly increase the risk of lung infection in COPD patients, and the mechanism may be related to the expression of TLR7/IL-17/IL-23.